eMedicine Specialties > Emergency Medicine > Neurology

Vestibular Neuronitis: Differential Diagnoses & Workup

Author: Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Nov 6, 2009

Differential Diagnoses

Benign Positional Vertigo
Central Vertigo
Labyrinthitis
Migraine Headache
Stroke, Hemorrhagic
Stroke, Ischemic

Other Problems to Be Considered

Cerebellopontine angle tumors

Workup

Laboratory Studies

  • Laboratory studies generally do not help determine the etiology or type of vertigo.
  • However, laboratory studies may be useful to help distinguish between vertigo and other types of dizziness such as light-headedness.
  • Consider abnormal serum glucose, anemia, or any ongoing cardiac dysrhythmia when patients report feeling light-headed.

Imaging Studies

  • Cerebral imaging may be necessary to assess causes of central vertigo.
    • Possible causes of central vertigo include the following:
      • Cerebellar bleeds
      • Infarcts and tumors
      • Lesions of the brain stem
      • Cerebellopontine angle tumors
      • Multiple sclerosis
    • Because significant bony artifacts degrade CT images of the posterior fossa, MRI is the preferred imaging modality when available.
  • Imaging generally is not indicated in patients with isolated vertigo, in those with no history or physical findings that suggest any diagnosis other than vestibular neuronitis, and in those without cerebrovascular disease risk factors. A lower threshold for imaging should be maintained for elderly patients or those with risk factors for cerebrovascular disease. These patients have a higher risk for a central cause of vertigo, even when no other symptoms manifest. In one study, 10% of patients with cerebellar infarction presented with isolated prolonged vertigo suggestive of vestibular neuronitis.7

Procedures

  • Perform the Hallpike maneuver on all patients who complain of vertigo but do not exhibit nystagmus on routine examination of the extraocular muscles.
    • Hallpike maneuver requires patient to lie back from sitting to supine position 3 times. The first time, have the patient lie back with the head facing forward and the neck slightly extended; repeat this movement with the patient's head turned 45 degrees to the right and a third time with the head turned 45 degrees to the left.
    • Instruct patient to keep both eyes open each time he or she lies back.
    • Check for nystagmus and ask patient about any symptoms of vertigo.
    • Among the characteristics of an elicited nystagmus that would suggest disease of peripheral origin are a pause before nystagmus appears (latency), unidirectional nystagmus, and fatiguing of nystagmus after approximately 1 minute or repeated inductions.
    • Failure either to observe or to provoke unidirectional nystagmus casts doubt on whether the process is localized to the peripheral vestibular system. Either finding suggests a need to consider other diagnostic alternatives.

More on Vestibular Neuronitis

Overview: Vestibular Neuronitis
Differential Diagnoses & Workup: Vestibular Neuronitis
Treatment & Medication: Vestibular Neuronitis
Follow-up: Vestibular Neuronitis
References
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References

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Further Reading

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Keywords

vestibular neuronitis, vestibular neuropathy, inflammation of the vestibular nerve, vertigo, dizziness, reactivation of latent herpes simplex virus type 1, herpes simplex virus, vertiginous episodes, rapid head movement  

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Contributor Information and Disclosures

Author

Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Medtronic Ownership interest None; Cambridge Heart, Inc. Ownership interest None

Medical Editor

Peter MC DeBlieux, MD, Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University Health Sciences Center
Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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